Soul-Satisfied, but Heartbroken: The ‘Soft’ Skills of Oncology Nurse Navigators

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is part of a series on mountains as barriers that she is working on.

Untitled oil stick & charcoal on paper by Julianna Paradisi Untitled oil stick & charcoal on paper by Julianna Paradisi

When I introduce myself to nurses as an oncology nurse navigator, they often respond, “Oh, that’s great,” staring blankly. Sometimes, in the midst of patient care, they say, “Yeah, that’s great, but I’m really busy. Come back later.”

Nurses caring for patients are really busy—so busy that this is one of the reasons the relatively new specialty of nurse navigators exists. Another reason is that oncology care is increasingly complex, and mostly occurs in the outpatient setting where vulnerable patients must fend for themselves.

Patient navigation was founded in 1990 by Harold P. Freeman at Harlem Hospital Center to improve outcomes for poverty-stricken African-American women presenting with stage III and IV breast cancer. Freeman declared, “The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.”

In 2010, the Affordable Care Act (ACA) mandated patient navigation for oncology by 2015. No longer […]

2016-11-21T13:02:21-05:00June 22nd, 2015|career, Nursing, nursing perspective, Patients|0 Comments
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An Updated Code of Ethics for Nurses as a Call to Action

By Katheren Koehn, MA, RN, executive director of the Minnesota Organization of Registered Nurses (MNORN) and a member of AJN‘s editorial board.

YearofEthics2015In January, the American Nurses Association declared 2015 to be “The Year of Ethics,” to highlight the first revision to the Code of Ethics for Nurses with Interpretive Statements since 2001. Last week, in Baltimore, ANA hosted an Ethics Symposium to facilitate a dialogue about just what the Code means to nursing practice.

This was not your typical esoteric ethics conference, with terms like beneficence, nonmaleficence, fidelity, and utilitarianism floating throughout the sessions. At this symposium the Code of Ethics became a unifying “Call to Action” for the profession.

In welcoming comments, Patricia Davidson, dean of Johns Hopkins School of Nurses, spoke of how ethical practice is critical for improving health care, especially with the move to person-centered care. She reminded us of the moral imperative to address entrenched health disparities, including access to care, and urged each of us to summon our own courageous leadership as we advocate for patients and families and question “entrenched beliefs.”

ANA President Pam Cipriano gave an overview of the Code of Ethics for Nurses, which articulates the ethical obligations and duties of every nurse. The Code binds us together, according to President Cipriano, no matter what practice setting we work in, or job title we hold. It is our nonnegotiable ethical standard, […]

2016-11-21T13:02:22-05:00June 17th, 2015|career, Ethics, Nursing, nursing perspective|0 Comments
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MERS: Where Are We Now and What Do Nurses Need to Know?

WHO map of MERS cases by country WHO map of MERS cases by country. Click to enlarge.

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Middle East respiratory syndrome (MERS) first emerged in Saudi Arabia in September 2012. Until last month, most MERS cases have occurred in that country. But on May 20, South Korea reported its first laboratory-confirmed case of MERS, in a 68-year-old man who had recently returned from a business trip to the Middle East.

The diagnosis was made only after the man had visited four health care facilities since his return home. This resulted in nosocomial transmission to other patients, health care workers, and visitors. To date, the Republic of Korea’s Ministry of Health has identified 108 cases of MERS in South Korea. Nine patients (all with serious preexisting health conditions) have died.

The WHO notes that all of these cases are epidemiologically linked to the index case. That is, there is no evidence that a new “reservoir” of MERS virus has suddenly surfaced in South Korea—all cases thus far stem from the Korean traveler who acquired his infection while visiting the Arabian Peninsula.

This is the largest outbreak of MERS so far outside of the Middle East, and therefore a reason for some concern. However, person-to-person transmission of MERS is not new, and there has as yet been no sustained […]

2016-11-21T13:02:22-05:00June 15th, 2015|infectious diseases, Nursing, nursing perspective|0 Comments
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A Case of Early PEG Tube Dislodgment—What Can We Learn?

By Sylvia Foley, AJN senior editor

Figure 2. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA.

Percutaneous endoscopic gastrostomy (PEG) tubes are widely regarded as “one of the most useful” means of delivering enteral nutrition—but when things go wrong, the results can be devastating.

Consider the following case, presented in one of June’s CE features, “Early Percutaneous Endoscopic Gastrostomy Tube Dislodgment”: Mr. J. B., a man in his fifties, was involved in a motor vehicle accident and developed an extending, chronic subdural hematoma. After undergoing an emergency craniotomy, he suffered neurologic deterioration and respiratory failure. Treatment included the placement of a PEG tube for nutritional support, but when Mr. B. later became confused and agitated, he forcibly dislodged the tube. The bedside nurse “inserted a Foley catheter to replace the PEG tube, drew an air bubble out of the catheter to confirm gastric placement, noted this, and then reported the event to the facility’s attending physician, who acknowledged and approved the […]

2017-07-27T14:40:37-04:00June 12th, 2015|Nursing|0 Comments
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Family Caregivers Increasing in Age, Numbers: How Can Nurses Help?

By Shawn Kennedy, MA, RN, AJN editor-in-chief

AJNFamilyCaregiverSupplementLast week, a new report from the National Alliance for Caregiving and AARP detailed the landscape of family caregiving in the United States. The majority (60%) of caregivers remain female (40% are men, a percentage that continues to rise). They average 49 years of age. In most cases, they are caring for a relative (typically, a 69-year-old female). On average, the caregiver spends 24 hours each week helping with daily activities and has been doing so for four years; one-third of caregivers still maintain a full-time job.

An estimated 34.2 million adults provided unpaid care to an adult 50 years or older in the previous 12 months; nearly one in 10 caregivers is 75 years or older—a typical example given in the report was a 79-year-old female caring for a 77-year-old spouse with Alzheimer’s disease, aging issues, or heart disease. Half of caregivers were thrust into caregiving and felt that they had no choice about taking on the responsibility of a loved one’s care; 22% of caregivers feel that their own health has suffered.

To raise awareness of their needs, in recent years AARP has championed the plight of family caregivers, collaborating with government and consumer organizations, and health care professionals. AJN, too, has worked with AARP on several projects to provide nurses with information to support family […]

2016-11-21T13:02:26-05:00June 10th, 2015|Nursing, nursing perspective, Patients, Public health|0 Comments
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